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Bone Marrow (414228)
Bone Marrownew
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munafdesai
2012-03-30 07:49
INCTR - EBMWG Hematopathology Online
M/69 yrs, pancytopenia, high ESR, hypersplenism, hepatomegaly, abnormal LFT, no blast on peropheral blood film
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tzankov
2012-04-02 08:12
this is a hypercellular bone marrow with a diffuse infiltration by a rather monotonous, rather immature, mitotically-active, highly likely neoplastic cellular population. The population should be specifically anlyzed using additional stains for PAS, Giemsa, myeloid (MPOX, CD34, CD33, CD68, CD11c, CD14) and lymphoid markers (CD5, CD20). The result should be compared with the aspiration cytology and the FACS of the bone marrow cells.
munafdesai
2012-04-03 14:48
I have added IHc images.
munafdesai
2012-04-03 15:06
Some areas on H&E and retic stain are giving impression of hairy cell leukemia. But, IHc is not supporting it (Neg cdc79a)
tzankov
2012-04-04 08:20
Well, the IHC is not perfect, but it is interpretable, the neoplastic cells are CD20+/MPOX- and highly proliferating; CD10, BCL6, BCL2 and TdT must be added. CD79a might be false negative (are there internal positive controls?).  
 
From what we see we can conclude for the moment, that there is a displacing infiltration of the bone marrow by an "aggressive" B-NHL. The differential is high grade follicular lymphoma, DLBCL, further, though less probable, mature B-ALL. What are the results form the FACS of the bone marrow lymphocytes?
tzankov
2012-04-04 08:22
Well, the IHC is not perfect, but it is interpretable, the neoplastic cells are CD20+ and highly proliferating; CD10, BCL6, BCL2 and TdT must be added. CD79a might be false negative (are there internal positive controls?).  
 
From what we see we can conclude for the moment, that there is a displacing infiltration of the bone marrow by an "aggressive" B-NHL. The differential is high grade follicular lymphoma, DLBCL, further, though less probable,
munafdesai
2012-04-04 17:19
Thank you Dr Tznakov  
CD10 is positive and CyclinD1 is negative. It looks like high grade B cell lymphoma, but no palpable lymph nodes(CT abdomen/chest reports – to follow).  
I have also posted images of some lymphocytes from the blood film, are they hairy cells or artifacts?  
tzankov
2012-04-05 11:58
Please stain the case for TdT
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Last modified: 2012-03-30 18:04:27